A new aid for revision spine surgery with more selective dissection.
Our experience more than10 cases: ideal case to start and bad case with limitation of the system
Additional direct cost of ADTs
Webinar Auxin 15.12.2021 A new aid for revision spine surgery with more selective dissection.
Our experience more than10 cases: ideal case to start and bad case with limitation of the system
Additional direct cost of ADTs
5 cryo caytery dr. sharda jainUsed to cool special heads via gun {minus 70 de...Lifecare Centre
An old usage is a cauterant, a chemical used to burn!
Very cold and causes lots of tissue destruction can be over applied and cause full thickness skin loss.
A new aid for revision spine surgery with more selective dissection.
Our experience more than10 cases: ideal case to start and bad case with limitation of the system
Additional direct cost of ADTs
Webinar Auxin 15.12.2021 A new aid for revision spine surgery with more selective dissection.
Our experience more than10 cases: ideal case to start and bad case with limitation of the system
Additional direct cost of ADTs
5 cryo caytery dr. sharda jainUsed to cool special heads via gun {minus 70 de...Lifecare Centre
An old usage is a cauterant, a chemical used to burn!
Very cold and causes lots of tissue destruction can be over applied and cause full thickness skin loss.
Gastric Banding is a type of bariatric surgery. This surgery involves inserting the external instrument. You have to follow the instruction before the surgery to get recovered quickly. Always consult your doctor about the risks before the procedure.
Rotator Cuff Update 2022 for Medbelle Len Funk.pptxLennard Funk
the common questions patients will ask once they have had a scan and a tear has been reported, particularly if they have had no injury of trauma, they ask what caused my tear. If I have a tear what can you do to fix it, it’s got to be fixed. How can I get better if it is not fixed. I have already had physiotherapy and that didn’t fix it so how will more physiotherapy. Some patients who are not keen on surgery, do I really need to have an operation. I have not had an injury.
there are multiple options thrown into the mix here which we need to consider for an individual patient.
The below illustration shows a very rough decision making tool that I would use in determining surgical or treatment options for particular patients.
A younger patient who has both pain and weakness with a massive cuff tear, if it is partially repairable a biological augment would be suitable.
If their predominant weakness is external rotation i.e. a positive Hornblower sign but good elevation, a lat dorsi tendon transfer.
For an older patient who has a predominant weakness but no significant pain, deltoid rehabilitation programme is indicated.
If they do have pain, a suprascapular nerve procedure such as an ablation would be beneficial.
For those that have significant pain and weakness with failed non-operative options, a reverse shoulder replacement would be the best option.
The balloon as we said, has a very limited place and this is for the older patient with slight loss of function and pain with higher demands.
For those that have more significant pain and elevation weakness, a superior capsular reconstruction would be my preferred option.
An up to date on the management of the acute abdomen. Including case presentations of x-rays, CT scans & laparoscopy images and the highlights of their management. Mainly intended for surgical trainees preparing for their exams.
PREVENTIONandTreatment of Sleeve Gastrectomy Leaks
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
LSG exposes severe complications occurring in patients with benign condition.
Endoscopic stents entail high failure rate.
Total gastrectomy is required in one third of the cases.
Liposuction is a surgical procedure that removes excess fat from specific areas of the body. During the procedure, a small incision is made, and a thin tube called a cannula is used to suction out the fat. Liposuction can be used to contour and reshape the body, but it is not a weight loss solution or a substitute for a healthy lifestyle.
wound management briefing training course including wounds, wound healing & wound types, wound closure, wound covers, wound dressings and marketing plan for new product launch, wound assessment types and measures.
for HCP , wound care specialists, nursing, and wound care and health associations
Iridodialysis repair with modified double armed closed chamber techniqueRidho Ranovian
To elaborate the modified closed-chamber technique with ICCE in managing subtotal iridodialysis with traumatic cataract due to contusion ocular trauma.
La chirurgie des tumeurs cérébrales: matinée scientifique CHwapi Tournai 25 m...Michel Triffaux
Dans le cadre du mois international de sensibilisation des tumeurs cérébrales de Gris en Mai 2024, la Consultation d'Oncologie Multidisciplinaire de Neuro du CHwapi a organisé trois évènements: un conférence tout public à l'Hôtel de Ville de Tournai le 13 mai , une journée de sensibilisation dans le hall de l'hôpital site Union le 22 mai et une matinée scientifique pour les professionnels le 25 mai.
Il s'agit de la partie chirurgicale du traitement des tumeurs cérébrales
Présentation actualisée de la situation au 01 juin 2023 du registre belge spine version 2.0
Nouvelle nomenclature INAMI en Spine.
Contraintes administratives et perte de l'intérêt scientifique du 1er registre.
More Related Content
Similar to A new aid for spinal revision surgery: the Cadiss°
Gastric Banding is a type of bariatric surgery. This surgery involves inserting the external instrument. You have to follow the instruction before the surgery to get recovered quickly. Always consult your doctor about the risks before the procedure.
Rotator Cuff Update 2022 for Medbelle Len Funk.pptxLennard Funk
the common questions patients will ask once they have had a scan and a tear has been reported, particularly if they have had no injury of trauma, they ask what caused my tear. If I have a tear what can you do to fix it, it’s got to be fixed. How can I get better if it is not fixed. I have already had physiotherapy and that didn’t fix it so how will more physiotherapy. Some patients who are not keen on surgery, do I really need to have an operation. I have not had an injury.
there are multiple options thrown into the mix here which we need to consider for an individual patient.
The below illustration shows a very rough decision making tool that I would use in determining surgical or treatment options for particular patients.
A younger patient who has both pain and weakness with a massive cuff tear, if it is partially repairable a biological augment would be suitable.
If their predominant weakness is external rotation i.e. a positive Hornblower sign but good elevation, a lat dorsi tendon transfer.
For an older patient who has a predominant weakness but no significant pain, deltoid rehabilitation programme is indicated.
If they do have pain, a suprascapular nerve procedure such as an ablation would be beneficial.
For those that have significant pain and weakness with failed non-operative options, a reverse shoulder replacement would be the best option.
The balloon as we said, has a very limited place and this is for the older patient with slight loss of function and pain with higher demands.
For those that have more significant pain and elevation weakness, a superior capsular reconstruction would be my preferred option.
An up to date on the management of the acute abdomen. Including case presentations of x-rays, CT scans & laparoscopy images and the highlights of their management. Mainly intended for surgical trainees preparing for their exams.
PREVENTIONandTreatment of Sleeve Gastrectomy Leaks
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
LSG exposes severe complications occurring in patients with benign condition.
Endoscopic stents entail high failure rate.
Total gastrectomy is required in one third of the cases.
Liposuction is a surgical procedure that removes excess fat from specific areas of the body. During the procedure, a small incision is made, and a thin tube called a cannula is used to suction out the fat. Liposuction can be used to contour and reshape the body, but it is not a weight loss solution or a substitute for a healthy lifestyle.
wound management briefing training course including wounds, wound healing & wound types, wound closure, wound covers, wound dressings and marketing plan for new product launch, wound assessment types and measures.
for HCP , wound care specialists, nursing, and wound care and health associations
Iridodialysis repair with modified double armed closed chamber techniqueRidho Ranovian
To elaborate the modified closed-chamber technique with ICCE in managing subtotal iridodialysis with traumatic cataract due to contusion ocular trauma.
La chirurgie des tumeurs cérébrales: matinée scientifique CHwapi Tournai 25 m...Michel Triffaux
Dans le cadre du mois international de sensibilisation des tumeurs cérébrales de Gris en Mai 2024, la Consultation d'Oncologie Multidisciplinaire de Neuro du CHwapi a organisé trois évènements: un conférence tout public à l'Hôtel de Ville de Tournai le 13 mai , une journée de sensibilisation dans le hall de l'hôpital site Union le 22 mai et une matinée scientifique pour les professionnels le 25 mai.
Il s'agit de la partie chirurgicale du traitement des tumeurs cérébrales
Présentation actualisée de la situation au 01 juin 2023 du registre belge spine version 2.0
Nouvelle nomenclature INAMI en Spine.
Contraintes administratives et perte de l'intérêt scientifique du 1er registre.
Spine Unit Lombalgies et Radiculalgies des Guidelines à la pratiqueMichel Triffaux
Matinée scientifique du CHWapi
Invitée Dr P Jonckheer: trajet de soins national KCE
Prise en charge aux urgences, Place de la Médecine Physique, Place du kinésithérapeute, Place de la Pain clinic, Place de la Radiologie, Place de la chirurgie et Spine Unit mode d'emploi.
Présentation par différentes disciplines de la Spine Unit du CHwapi.
eXLIF or DLIF about 20 consecutive cases whit Ursus cages by Syntropiq Michel Triffaux
XLIF or DLIF about 20 consecutive cases whit Ursus cages by Syntropiq.
Arosa NSpine winter meeting.
The advantage of anterior and lateral approach is reviewed. The main problem remains the lumbar plexus.
The knowledge of bone fusion is important to this kind of surgery.
The dynamic contact surface in Ursus cage promotes bone fusion by mechanical stimulation.
Preliminary study about 20 consecutive cases.
Nouvelle Nomenclature en Chirurgie du Rachis en date du 1er septembre 2022 Michel Triffaux
Présentation pour du GLEM de Neurochirurgie du 6 octobre 2022 à l'Hôpital Marie Curie Charleroi
Depuis le 1er septembre 2022 une nouvelle nomenclature en chirurgie du rachis est entrée en application.
De nouvelles règles ont été établies pour les consultations de la Spine Unit à l'image des consultations multidisciplinaires d'oncologie.
Les implications du nouvel arrêté sont analysé par un praticien de terrain coordinateur chirurgical de la Spine Unit du CHwapi Tournai Belgium
The value of dynamic MRI in cervical spondylotic myelopathy: About 24 cases.T...Michel Triffaux
Dynamic magnetic resonance imaging (MRI) of the cervical spine is extremely useful in assessing
pathological changes at the spinal cord, vertebrae, discs, ligaments and facet joints. we attempted to
document the radiological changes that the cervical spine undergoes during dynamic maneuvers and the
effects of Dynamic MRI in management of cervical myelopathy, emphasizing on the changes in treatment
protocol effected by the new findings discovered. Our work is based on 24 consecutive patients with
cervical spondylotic myelopathy had cervical MR imaging in neutral position, in flexion and extension of
the cervical spine between January 2021 and December 2021. The result found the mean age was 57.9
years (range 26-85 years). Among these 24 patients, there were 11 males and 13 females. Total number of
levels of compression were 47 and the additional levels of involvement were 17. Additional levels of
compression were noted in 12 patients, among these 17 new levels, 7 were in the posterior and 10 in the
anterior. The most affected level was C5C6 with 16 cases. All additional levels of compression were noted
in extension; Reduction of the cervical canal was observed in 20 patients only in extension. In the bending
sequences we have noticed an increase of the canal diameter in 3 patients. The location of the
compression is in 15 cases anterior, 2 cases posterior and 5 cases are mixed anterior and posterior
Surgery was considered in 17 patients. Anterior procedures were 11 (ACDF/ corpectomy and fusion) and
Posterior surgeries were 6 (laminoplasty/laminectomy), and. The rest of the patients did not require
surgery and was conservatively treated. A change of the signal was found in 3 patients during the
acquisition in extension position a. Most studies have shown a reduction of the root canal with an increase
of the compression level, which was the case in our study. MRI is a useful tool for diagnosis of CM, it does
not give an exact idea as to which is the offending level in a multilevel compression that requires surgery.
Even the approach and procedure cannot be decided on a static examination and hence are subject to
significant interpractitioner the role of extension MRI in determining cervical compression levels. Thus,
dynamic cervical spine MRI should be an important investigation before we decide to write off surgical
treatment in patients with cervical myelopathy and cord signal changes without definitive compression on
static MRI. Flexion and extension MRI is an important tool for decision making and planning appropriate
management in cervical compressive myelopathy.
The Utility of the CADISS® System in the Dissection of Epidural Fibrosis in ...Michel Triffaux
Spine surgery and spinal fusion surgery are rising. Revision rates following initial surgery are between 8
and 45%. Epidural fibrosis is a common response to spine surgery for most patients and increases
complications in revision surgery. Previous research suggests using MESNA (Sodium 2-mercaptoethane
sulfonate) in combination with mechanical blunt dissection safely reduces surgical complications. MESNA is
a mucolytic agent which selectively cleaves disulphide bonds involved in the adherence and strength of
fibrosis, meaning cutting instruments are not needed. The Chemically Assisted DISSection (CADISS®)
System is an optimised non-cutting surgical device, consisting of a reconstitution cartridge for MESNA
preparation, irrigated surgical instruments, and a footswitch to control MESNA release. This is the first study
to investigate the use of the CADISS® System in revision spine surgery.
Reversible hearing loss after 3D video-assisted marsupialization of several ...Michel Triffaux
Case report
Very few pediatric cases of arachnoid cyst of ponto-cerebellar angle are desribed in the literature. Only 4 are
described with hearing loss. It is a pathology which poses especially a problem of early diagnosis. In this paper
we describe the management of a 16-year-old patient with an arachnoid cyst of the cerebellopontine angle with
an isolated auditory deficit that was treated surgically. The follow up was marked by a Full recovery of hearing
after surgical treatment. Arachnoid cyst of the cerebellopontine angle is rare in the pediatric population, early
surgical management help to increase the chances of recovery.
Obstruction of ventriculoperitoneal shunt by air bubbleMichel Triffaux
Neurosurgery case report
Obstruction of ventriculoperitoneal shunt
This case illustrates the management of this rare situation causing air bubble shunt obstruction.
IRM dynamique dans la myéolopathie cervico arthrosiqueMichel Triffaux
Communication du Dr Marouane Makhchoune felow du service de neurochirurgie FOSFOM au CHWapi Tournai Belgium lors du congrès de la SFCR Nice 2022.
Etude radiologique sur l'intérêt de réaliser des épreuves dynamiques en flexion - extension lors d'une IRM cervicale. Modification dans la stratégie chirurgicale: confirmation d'une absence d'indication chirurgicale ou modification de la voie d'abord postérieure versus antérieure.
Objet du mémoire en vue de l'obtention d'un DU Paris Bicètre sur les pathologies de la moelle épinière.
Direct Tubular Exo sequestromy for Far Lateral Disc Hernia Michel Triffaux
Application of the Orbeye Exoscope for direct tubular sequestromy for far lateral disc hernie.
Minimal Invasive Surgery
Spine Unit CHwapi 7500 Tournai Belgium
Orbeye Exoscope qui permet la Microchirurgie sans microscope.Michel Triffaux
Présentation à la presse du nouveau exoscope Orbeye par le CHwapi service de neurochirurgie.
Introduction Dr M Triffaux
Ce qui change pour l'équipe Mme S Fourez
L'Orbeye en chirurgie du rachis MIS Dr A Bouras
L'Orbeye en chirurgie intracrânienne Dr S Lonneville
Microchirurgie 3D 4K sans microscope: Orbeye Exoscope Michel Triffaux
Présentation au Comité de Gestion CHwapi mai 2021
Renouvellement du microscope en neurochirurgie
Alternative au microscope opératoire conventionnel pour la microchirurgie
Cours IESPP Pathologies Chirurgicales
Infirmières Hospitalières 2ème année
Nouvelle édition 2019 2020 revue et augmentée
La peau: description rôles et fonctions
Microsurgery without eyepieces 3D screen heads-up position Michel Triffaux
Microsurgery without microscope. In summer 2019, in the neurosurgery department of the CHwapi Tournai Belgium
we had the chance to test three different systems of microscope without eyepieces: Kinévo 900 (Zeiss), Orbeye (Olympus) and Digital Surgery Microscope (BBraun Aesculap).
Présentation de la Spine Unit du CHwapi Tournai à la Société Médicale du Tournaisis le 19 semptembre 2019.
Lombalgies Radiculalgies du KCE à la Spine Unit
Dr P Jooncker KCE, Dr A Poulain Med Phys, Dr M Triffaux Neurochirurgie, Dr D Lamblin Pain Clinic et Dr M Petit Chir. Orthopédique
Surgical Microscope Orbey Olympus en Neurochirurgie Michel Triffaux
Test de 4 semaines au sein du service de neurochirurgie du CHWAPI à Tournai Belgique
Premières impressions après 4 semaines de test
Images et commentaires
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
A new aid for spinal revision surgery: the Cadiss°
1. Cadiss®, a new aid for revision spine surgery
with more selective dissection
M. Triffaux
Neurosurgery, Spine Unit
CHwapi B 7500 Tournai
07 october 2021
2. Cadiss®: what is that ?
Epidural Fibrosis: the nightmare for the surgeon
Revision Spine Surgery: a real challenge
My Cadiss® experience: more than 10 uses
The Cadiss® what can and cannot do
9. Cadiss®, what is that ?
Is it too good to be true ?
No limitations in this study ?
?
10. Cadiss®, what is that ?
Is it too good to be true ?
No limitations in this study ?
?
?
11. Cadiss®, what is that ?
Is it too good to be true ?
No limitations in this study ?
No choice: I had to test it by myself …
10 cases / 6 months / 2 surgeons
It’s my opinion after 10 uses that I will
communicate to you
12. Cadiss®, what is that ?
Our limited experience after 10 cases
Study design
Dispositif CADDIS Auxin
Etude prospective 04.21
CAS __ __ AB SL MT
date op. : __ / __ / 2021
1. compléter Spine Tango dans HD4PD
2. Dans §4 Chirurgie technique item autre: CADDIS
3. ATCD infiltratif O non O inconnu O oui __ __ __ __ __ __ __ __ __
4. ATCD opératoire O non
O oui O même niveau O prévention par oxyplex, __ __ __ __ __ __ __
O type intervention précédante: O HDL O CLE O Fusion
O alt: __ __ __ __ __ __ __ __ __ __ __ __ __ __
délai entre les deux interventions __ __ mois __ __ années O non connu
5. Type d’intervention O HDL O CLE O FUSION 180° O à 360° O trauma
6. Modalités opératoires O open O MIS O NNV O arm
O autre: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
8. Fibrose canalaire O IRM O Ctscan O non évaluable
1./2
A B C D Total
___ /16 ___ /16 ___/16 ___/16 ___/16 _____ %
/16 % /16 %
2 13 10 63
4 25 12 75
6 38 14 88
8 50 16 100
A: 100 %. B: 75% C: 50% D: 25%
4 / 16 3 / 16 2 / 16 1/ 16
Niveau: L2 L3 L4 L5 S1
13. Epidural Fibrosis a nightmare ?
• Pathologic epidural fibrosis is a fibroblastic scare
• Hematoma of operative field is invaded by fibroblastes
and becomes granulation tissue
16. Epidural Fibrosis a nightmare ?
• How to prevent the fibrosis ?
https://doi.org/10.1016/j.jot.2018.02.001
17. Epidural Fibrosis a nightmare ?
• How to prevent the fibrosis ?
• Good hemostasis ? Less bipolar use ?
18. Epidural Fibrosis a nightmare ?
• How to prevent the fibrosis ?
• Good hemostasis
• Suction drain
• MIS : smaller incision & less muscle trauma
• Preservation of epidural fat
• Preservation of ligamentum flavum
• Topic corticosteroid
19. Epidural Fibrosis a nightmare ?
• How to prevent the fibrosis ?
• Free fat grafting
• Barrier GEL
20. Epidural Fibrosis a nightmare ?
• How to prevent the fibrosis ?
• Free fat grafting
• Barrier GEL
• Barrier menbrane
21. Epidural Fibrosis a nightmare ?
• How to prevent the fibrosis ?
• Free fat grafting
• Barrier GEL
• Barrier menbrane
• Immunosuppressor Mitomycine C MMC
• Application of stem cells
• low dose radiotherapy
22. Epidural Fibrosis a nightmare ?
• Why that is a problem ?
• FBSS
• Revision surgery
• Accidental Dural Tears X3 > 16% ( // age, lumbar stenosis)
• Operative time > 6 h
• Lenght of hospital stay
23. Epidural Fibrosis a nightmare ?
• Why that is a problem ?
• more and more revision 5-18%
• an increasingly older population
• Belgian situation arond 2010
24. Epidural Fibrosis a nightmare ?
• Why that is a problem ?
https://asma.social/assets/209
27. Epidural Fibrosis a nightmare ?
• The ADTs
• Incidence X3 for revision surgery -> 16%
• 10 steps algorithm for treatment
• Additional cost > 1.000 € ? / ADTs cf our cost study
28. Epidural Fibrosis a nightmare ?
• The additional cost of the ADTs
Study on the hospital bill of 10 consecutive ADTs cases
3 month period : 10 ADTs/ 167 = 6%
29. Epidural Fibrosis a nightmare ?
• The additional cost of the ADTs
Study on the hospital bill of 10 consecutive ADTs cases
Population: Revision 3 t, trauma 1 : B2 Th L
30. Epidural Fibrosis a nightmare ?
• The additional cost of the ADTs
Study on the hospital bill of 10 consecutive IDTs cases
Treatment of ADTs, 1 unresolved (trauma)
31. Epidural Fibrosis a nightmare ?
• The additional cost of the ADTs
Study on the hospital bill of 10 consecutive IDTs cases
Additional direct cost / ADTS: 1.140 €
32. Spinal revision a real challenge
• Spinal revision surgery is complexe and ungrateful
• It’s a succesion of small details
• Good results are not always there
33. Spinal revision a real challenge
• Pre op evaluation
• Change the approach ?
• Keep the bone contact
• Do not tear off
• Dissolve fibrosis ?
34. Our experience more than 10 cases
• Prepare the cartridge and the cannulated dissector
35. • Prepare the cartridge and the cannulated dissector
Our experience more than 10 cases
36. Our experience more than 10 cases
• Ideal case to start:
Posterior Interbody Fusion for late reccurent disc hernia
37. Our experience more than 10 cases
• Ideal case to start:
Posterior Interbody Fusion for late reccurent disc hernia
38. Our experience more than 10 cases
• Another case if you are not convinced: try on implants
It’s even easier to see the work of the Cadiss®
39. Our experience more than 10 cases
• A bad case :
67 ans y.o. man with comorbidity ++
1992 First arthrodesis L4L5
2008 AMOS Laminectomy L2L3L4 // DH L2L3
2019 Laminectomy Th12 L1 re L1L2L3L4: ADT
2021 Neurogene claudication
44. Our experience more than 10 cases
• Our 10 consecutive cases with Cadiss®
6 month period, 10 / 291 = 3,5 % , ADTs 1 with BS
45. The Cadiss® wath can and cannot do
This can facilitate dissection in epidural fibrosis
BUT 1. minimize the thicknes of epidural fibrosis
2. take the time for the product to work
3. wash the operative area with PL
AND 1. reduce the operating time
2. reduce the IDTs, reduce bleeding
3. reduce the lenght of hospital stay
It is same as hemostatic products, you always need to do a
good hemostasis: a careful dissection always be done
46. The Cadiss® wath can and cannot do
Other indications ?
epidural chimical adhesiolysis ?